Searching for a cure for pediatric food allergies

Food allergies affect one in every 13 American kids, yet when a child is diagnosed, modern medicine can't do much to help. As parents of newly diagnosed kids quickly learn, the standard advice is to avoid allergy triggers completely, since that's the only surefire way to prevent life-threatening episodes of anaphylactic shock. Many of the common allergy triggers - such as wheat, cow's milk, soy, eggs and peanuts - are so ubiquitous that avoidance becomes a herculean task. Families have to be extra-cautious about everything from restaurant meals and school events to birthday parties and sleepovers at friends' homes. In addition to the stress they cause for affected families, food allergies take a big medical toll. They're responsible for 90,000 episodes of anaphylactic shock each year and 2,000 hospitalizations.

It's hard enough if your child is allergic to just one food. But a growing number of children have severe allergies to multiple foods. Fortunately, a scientist at Stanford and Lucile Packard Children's Hospital is working to help these kids. Building on a body of work - her own and others' - demonstrating that it's possible to safely desensitize children to a single food allergen, Kari Nadeau, MD, PhD, is now trying to find treatments that will address multiple food allergies simultaneously. Her quest is described in a new feature in this week's New York Times Magazine:

Could patients be desensitized to more than one allergen at a time? No one had ever tried it, but more than a third of children with food allergies are allergic to more than one food. If it was safe to give patients x milligrams of one allergen, would it be safe to give them one-fifth of x milligrams of five different allergens, as long as the total dose remained the same? That would assume that allergens function in a linear, additive fashion — rather than a multiplicative one; it was also possible that they could interact with one another to produce a more severe reaction.

Nadeau experimented with blood samples of allergic patients and was encouraged to see that the allergens seemed not to interact with one another. She consulted with senior colleagues in the field to see if anyone would collaborate on a multiallergen study, but no one was interested. Scientifically the results would be harder to interpret than single-allergen trials. Moreover, each allergen would require getting separate F.D.A. approval, and it was difficult to get even one application approved. When she found herself home sick in bed with a virus for a few days in 2011, she decided she would “knock them all out” and wrote 13 Investigational New Drug Applications, each 90 or so pages long, and soon received F.D.A. approval for each one.

The entire story is a fascinating behind-the-scenes look at the science of immunology, and well worth reading. Those interested in learning more about Nadeau's ongoing projects should check out her research group's website.

The scenario many of us learned in school is that two X chromosomes make someone female, and an X and a Y chromosome make someone male. These are simplistic ways of thinking about what is scientifically very complex.